Chiu-Tung Chuang

Ocular Uveitis as the Initial Presentation of Syphilis

Background: To document the characteristics of syphilitic patients who present with ocular uveitis clinically and are diagnosed by an ophthalmologist first. Methods: Retrospective chart review of uveitis patients in the department of ophthalmology between 1992 and 2004 was done. We included only those patients with positive serologic tests, active ocular uveitis, and record of detailed examination. Results: There were 8 syphilitic patients (14 eyes) who presented with ocular syphilis clinically and who were diagnosed by an ophthalmologist first. The ocular diagnosis included panuveitis (11 eyes, 78.6%), anterior uveitis (2 eyes, 14.3%), and posterior uveitis (1 eye, 7.1%). Two patients (25%) had unilateral eye involvement, and 6 patients (75%) had involvement in bilateral eyes. One patient (2 eyes) with panuveitis also had bilateral exudative retinal detachment and chronic angle closure glaucoma. All 8 patients were negative for human immunodeficiency virus. Dark field examination of aqueous humor in 2 cases revealed Treponema pallidum, which was confirmed by immunofluorescent test. Treatment included systemic penicillin in 7 patients and oral tetracycline in 1 patient (due to penicillin allergy). Visual function and uveitis improved after treatment in all patients. Conclusion: Syphilis can be presented initially as ocular uveitis without obvious systemic manifestation. Ophthalmologists play an important role in the early diagnosis and treatment of syphilis. If treated early enough, the response is good, even if the patient is allergic to penicillin. Awareness of the multiple manifestations of ocular syphilis is the key to early detection of the disease.

Non-vitrectomizing vitreous surgery for premacular haemorrhage

Purpose:  We report three cases illustrating an alternative treatment option for premacular haemorrhage.

Ocular Sarcoidosis in Southern Taiwan

Purpose: To assess the clinical features of ocular sarcoidosis in southern Taiwan. Methods: A retrospective chart review of all patients diagnosed with sarcoidosis in Kaohsiung Veterans General Hospital between 1991 and 2008. Age, sex, clinical features, systemic manifestations, biopsy sites, ocular manifestations, and visual acuity were recorded. Results: A total of 55 sarcoidosis patients were identified. Of these, 19 cases had ocular manifestations, including 5 males and 14 females. Of the total, 41 cases (75%) were confirmed by biopsy. Females were significantly older than males at onset. Posterior segment was involved in 16 cases. In 13 patients, initial presentations were blurred vision (n = 11) and floaters (n = 2). Conclusions: Ocular symptoms are a major initial presentation in sarcoidosis. Posterior segment is commonly involved, and may lead to significant visual impairment if not managed properly. Ophthalmologists should be alert to detect these patients early.

Patterns and Etiologies of Uveitis at a Tertiary Referral Center in Taiwan.

ABSTRACT Purpose: To analyze the patterns and etiologies of uveitis at a tertiary referral center in Taiwan. Methods: This retrospective chart review of uveitis patients from January 2001 to December 2014 updates a previous study a decade ago (2003). Results: We identified 450 patients, among whom anterior uveitis was most common, followed by panuveitis, posterior uveitis, and intermediate uveitis. A specific diagnosis was identified in 331 patients. In 73 infectious uveitis cases, herpetic anterior uveitis was the leading cause, followed by endogenous bacterial endophthalmitis and acute retinal necrosis. In 258 non-infectious uveitis cases, HLA-B27-associated uveitis was most commonly seen, followed by Vogt–Koyanagi–Harada disease and Posner–Schlossman syndrome. Compared with our previous study, we found more viral infection and sarcoidosis but fewer cases of Behçet disease, tuberculosis, and toxoplasmosis. Conclusions: Our results provide useful information about the patterns and etiologies of uveitis in a selected population in Taiwan.

Reversible alopecia in Vogt-Koyanagi-Harada disease and sympathetic ophthalmia

BackgroundVogt-Koyanagi-Harada (VKH) disease and sympathetic ophthalmia (SO) are both autoimmune disorders targeting melanin-bearing cells, even though their etiologies are different. Both shared many ocular and systemic manifestations, including integumentary findings. Most of the literature focused on the ocular manifestations and related treatment. Alopecia was seldom mentioned.FindingsWe report one case of VKH disease and one case of SO. Both developed severe alopecia and early sunset glow fundus, which are probably due to incomplete treatment. Fortunately, the alopecia improved soon after systemic steroid treatment.ConclusionsEarly and complete treatments are important in the management of VKH or SO and prevent integumentary manifestation. Alopecia can be reversible after steroid treatment in time.

Cornelia De Lange Syndrome-A Case Report

Purpose: To report a rare case of Cornelia de Lange syndrome. Method: A case report with literature review. Results: A 5-month-old boy was admitted to the pediatric ward due to failure to thrive. Clinical manifestations included intrauterine growth retardation (birth body weight was 1900 grams), prematurity (gestational age was 35+3 weeks), small for gestational age (4141 grams, less than third percentile), choked easily, small hands and feet, short neck, hirsutism and cryptorchidism. Facial features with confluent eyebrow, thin lips, low anterior and posterior hairline, down-turned mouth angle, low-set ears and micrognathia were noted. Auditory brainstem response showed slight hearing impairment. Ophthalmologic examination revealed long curly eyelashes, bushy eyebrows and synophrys. No ptosis, strabismus, nystagmus or other ocular abnormalities were found. The diagnosis was based on typical and unique clinical features of Cornelia de Lange syndrome (CdLS). Conclusion: Cornelia de Lange syndrome is a syndrome of multiple congenital anomalies characterized by a distinctive facial appearance, prenatal and postnatal growth deficiency, feeding difficulties and malformations that mainly involve the upper extremities. We present such a rare case with typical manifestations.

Multiple Myeloma Presenting as Exophthalmos and Unilateral Central Retinal Vein Occlusion: A Case Report

Purpose: To report a case of multiple myeloma presenting with exophthalmos and central retinal vein occlusion. [Editor: The deleted text immediately to the right was not deleted by me.] syndrome associated with retinitis pigmentosa Method: A case report Results: An 88-year-old female patient complained of fullness sensation on in her right eye for several weeks. Three months before ocular presentation, lower back pain with mild numbness radiatinged to the bilateral lower legs was noted. Exophthalmometry revealed 18-mm and 9-mm in the right and left eye respectively. Magnetic resonance image demonstrated a mass lesion about 3×3.8 cm over the superior-lateral quadrant of the right orbit. Multiple myeloma of the right orbit was diagnosed after orbital tumor biopsy, systemic survey and bone marrow aspiration. After radiotherapy for 5 months, the orbital tumor size decreased but central retinal vein occlusion of the left eye was noted. The patient expired due tofrom Streptococcus pneumonia one week later. Conclusion: Ophthalmic presentations of multiple myeloma are rare and the incidence of multiple myeloma as an orbital tumor had beenis reported to be below 1%. Older patients presents with exophthalmos, with symptoms such as generalized fatigue, weight loss or bone pain on movement, the differential diagnosis of multiple myeloma should be included.

Endogenous Cortisol Level in Patients with Central Serous Chorioretinopathy

Purpose: To investigate the relationship between endogenous cortisol levels and central serous chorioretinopathy (CSCR). Methods: Endogenous plasma cortisol levels was determined in nine patients with acute unilateral CSCR and age and sex matched unilateral rhegmatogenous retinal detachment (RRD) patients and normal control. In CSCR group, the examinations were repeated at two-week, four-week and 12-week follow-up. Results: The mean value of the 8 am plasma cortisol level in the CSCR group had no significant difference with the mean value in the normal control group (8.70±5.48 ug/dl vs 10.29±6.07 ug/dl, p=0.844). Whereas, the mean value of the 8am plasma cortisol level in the RRD group (18.36±10.79 ug/dl) revealed significantly higher value than those in the CSCR group (p=0.013) and the normal control group (p=0.017). Conclusions: Our results could not support the relationship of endogenous cortisol with CSCR. CSCR might involve multiple pathway of pathogenesis, including non-cortisol one.